Under The Knife

Old is the New New?

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Mariano RiveraDellin Betances (10/4)
Tyler Kepner tossed out that Betances had a procedure similar to Mariano Rivera today, but with that aside, he outed something that I had never heard before. Mark Newman of the Yankees told the press that Betances' procedure was an "overlay TJ," a variant of the Tommy John procedure where the damaged ligament isn't removed, but instead left in place and the ligament is buttressed by the new tendon. Originally, it was thought that this would reduce the issue with proprioception that many TJ surgeries involve for patients, but the procedure is seldom used currently. It was a shock to me that Rivera's procedure, done in 1992, was an overlay. I'm not sure that "disqualifies" him from the possibility of being the first player into the Hall of Fame after having Tommy John, but it's interesting to me. It was certainly a successful procedure for Rivera and the Yankees can only hope that Betances, one of their top pitching prospects, has a fraction of that success when he comes back.

Jim Thome
There's a story going around that after signing off on the trade to the Dodgers, Jim Thome asked if they knew he couldn't play the field. I'm not sure if it's true-and no one would confirm it-but there's a big difference between "shouldn't" and "can't." Thome is reportedly of the opinion that he could only play the field in an emergency, and that standing for long periods can aggravate his back. The Dodgers seem to understand this and don't seem flustered to have acquired a guy who now figures to have somewhere between 20 and 30 plate appearances in a division chase. Even with the roster expansion negating any bench issues, and with the White Sox picking up some of his salary, this is a move that has me scratching my head. I can't help but think that Thome is either going to ask or be asked to do a bit more, risking injury. One possibility is to use the "McGwire model" that Tony LaRussa employed for a week or so in the next-to-last season of Mark McGwire's career, sending him to bat once in the first inning and then pulling him for the "real" first baseman.

Johnny CuetoBrandon Phillips
Cueto came off of the DL and showed his normal velocity, a good sign, especially since he kept that velocity pretty much throughout his 85-pitch outing. His command was solid, and he showed the ability to fool hitters. The Reds seem as if they're being reasonably cautious with Cueto. One good outing is just that, but it's better than he showed in quite a while. The Reds also had a bit of a confusing situation-if you page down a bit on C. Trent Rosecrans' game notes, you'll see that Brandon Phillips had to clarify his statement about his fractured wrist. If his 3-for-4 game with a homer wasn't enough explanation, Phillips admitted that, like many, he didn't understand the difference between a fracture and a break. (Quick tip: they're the same thing.) The fact is, Phillips is playing through the pain, playing well, and understands that if it gets worse, he'll have to have it taken care of surgically. It's a recovery measured in weeks, so there's no real danger to his 2010 season. While I'd rather see more caution, that's not how these Reds play, and with his results, it's hard to argue with Phillips right now.

David Wright
Wright returned to the lineup and was immediately mocked for his new S100 helmet. Yes, it's bigger, and yes, it's kind of funny looking, but it works. Having taken a 94 mph ball off the bean, I would think that Wright can take some jokes. (My advice? Show them this when they laugh, David. Or your last bank statement.) Wright's return from the concussion looks to be a success with more than a week without any symptoms. There's no reason to think it will be a problem in the short or long term, even with the unpredictability of concussions. With the new helmet, we can only hope there's no recurrence. If they'll stop laughing, maybe it will prevent a concussion for one of his teammates or opponents.

Johan Santana (10/4)Oliver Perez (10/4)
Dr. David Altchek got a workout, doing procedures on two different Mets pitchers the other day. Both were successful, but both surgeries tell us a bit more about how the Mets managed these injuries. Santana had four small chips removed from his pitching elbow, but the key here is that one of them had become lodged in the joint, making it impossible for him to have full range of motion and causing issues beyond the simple pain. Once it had moved to that area, Santana was shut down quickly. When floating free, bone chips can be asymptomatic, which appears to have been the case during Santana's 2008 and 2009 seasons, at least intermittently. Now that they're out, Santana is as good as he was in 2004, at least physically. As a bonus, Altchek was able to visualize Santana's UCL, which was fine. The story on Perez is similar: Altchek scraped away a significant portion of scar tissue that was causing the friction and "crunching" in Perez's knee. Scar tissue is the result of previous tears, something Perez hadn't reported before, and wasn't an issue when he signed his three-year deal. In other words, Perez's injury was new and may just explain at least some of why his season was such a failure. Both should recover fully and be ready for spring training.

Michael Young (9/12)
The Rangers don't need injuries at this stage of their chase. Moreover, they don't need an injury to a key player like Young, but he's headed for an MRI after he pulled up running to first base. While there's no word yet on the severity-hence the MRI, people-Young was in obvious pain and appeared frustrated as he was taken off the field. The team has several options at third base, but Young's leadership and drive is simply irreplaceable. The severity of the strain will determine how long he'll be out, though he'll likely not head to the DL. (It's September, so see Monday's note on how this changes the use of the DL.) We should know a lot more later today about the injury and about the Rangers' chances of staying in this chase.

Burke Badenhop
Normally, I'd probably ignore a guy like Badenhop. He's a back-end swing man for the Marlins and hardly a fantasy option in all but the deepest leagues. Still, I did see him on Friday when he made a rehab start for the Jupiter Hammerheads. He looked OK, and ended up helping his team get the win, though he looked uncomfortable and had a tendency to fidget with his shoulder. That's an indication that his trapezius is still bothering him... or maybe just that his uniform didn't fit well. It's tough to say, though his stuff was anything but overpowering, even against a High-A lineup. Badenhop will be back for the Marlins this week as they continue to struggle to keep up in the wild-card race.

Quick Cuts:Adrian Beltre was activated from the DL yesterday. We are now never going to talk about this again. ... The Mets say that recent tests show Carlos Beltran has "significant improvement" inside his knee. ... The Phillies will have Brett Myers throw on back-to-back days before activating him. ... No word at deadline about what, if anything, was found in imaging on Ken Griffey Jr.'s knees. ... Pablo Sandoval was out of the Giants' lineup with a sore calf. ... Tim Hudson was due to come back on Tuesday, but a three-hour rain delay isn't going to help. ... Travis Hafner missed a third game on Tuesday, but figures to be back in the lineup as soon as Thursday. ... Due to some changes in how I deliver UTK, I might miss more things that happen late or overnight. I apologize for this and will do my best to catch up the next day when it's a significant change.

Last year at the end of the season, they had a 14% chance to reach the World Series, per Clay's calculations. So, they have a 14% chance (in theory) to use a player for a maximum of 3 games and a maximum of 30 PA up to that point. Thome is due $1.4m from the Dodgers and they dealt a prospect of some value for that possibility.

That's the rough equivalent of pushing into a Hold Em pot with pocket deuces.

Start by considering what the Dodgers' win expectancy against various AL contenders would be in hypothetical WS matchups, with 4 games in the AL park and with potential DH's named "Loretta" and "Pierre".

Then consider it with Thome and his EQA in that lineup spot; its probably a pretty reasonable upgrade (given Thome's probably worth a couple tenths of a run a game over those guys).

When you consider the value of winning vs losing the world series in a sheer income manner, even a 5-10% upgrade in win probability could be worth the pittance of ~1 million over the base price of whoever else fills that roster spot. No one thinks that the prospect being traded here is particularly significant.

If anything, the trade is an indicator of how confident Colletti is in the Dodgers' status as a division favorite.

With all the major league vets being let go over the last few years (Edmonds, Lofton, Durham, etc.), if the market has changed that much, then perhaps some vets would take a minor league contract instead of an unwanted retirement.

There's also a salary issue. Teams aren't going to offer what those vets are used to playing for, for them to spend three-fourths of the year in the minors. And those vets aren't going to play for that much less, no matter how much they love the game.

It's my understanding that the native UCL is not typically debrided in a Tommy John procedure. What's left of the ligament is incorporated into the reconstruction upon closing. I think this is the way it's been done for a while. Am I getting the meaning of Betances' procedure wrong?

I lack the background to know the answer to this question with any degree of certainty but I'm sure Carroll knows (actually I'm by no means sure Carroll knows, I just phrased it this way to put pressure on Carroll to come up with the answer). Here it is: Who are the pitchers who have gone on to have successful Major League careers AS STARTERS (I don't want to hear about Rivera), after having TJ surgery BEFORE EVER REACHING the Majors? The thrust behind this question is my gut feeling that having TJ while in the low Minors (as Betances may have just had) is basically a death sentence when it comes to any potential he might have had as a Major League STARTING PITCHER.

So...can Will (or anybody) name for me the 3 or 4 or 5 most successful Major League STARTING PITCHERS, who had TJ BEFORE reaching the Majors? Who are these guys?

Keith Hernandez was the bozo on the Mets broadcast last night deriding the new helmet. Wearing it is one of the smartest moves Wright has made in his career, and he's made plenty of smart moves. Good going, David! Be sure to bring Keith a bottle of Hair Color for Men next time you see him.